title: The additive effect of co-occurring anxiety and depression on health status, quality of life and coping strategies in help-seeking tinnitus sufferers.
abstract: OBJECTIVE
  Evaluating the effect of anxiety and depression on clinical measures of general health, tinnitus-specific quality of life, and coping abilities.
  
  
  METHODS
  Two hundred sixty-five chronic, subjective tinnitus sufferers were divided into four psychological symptom groups according to cut-off scores on anxiety and depression subscales of the Hospital Anxiety and Depression Scale: (1) no-symptoms, (2) anxiety-only, (3) depression-only, and (4) anxiety-plus-depression. General health-related quality of life (SF-36), tinnitus-specific quality of life (tinnitus reaction questionnaire and tinnitus handicap inventory), and coping abilities (tinnitus coping style questionnaire) were assessed and analyzed across these four psychological symptom groups, which did not differ on age, gender, marital, and working status.
  
  
  RESULTS
  Statistically significant and clinically relevant differences on general health-related and tinnitus-specific quality of life and coping abilities were identified when comparing anxiety-plus-depression subgroup with the subgroups anxiety-only, depression-only, or no-symptoms. Highest associations were seen between the anxiety-plus-depression subgroup and impaired quality of life and maladaptive coping.
  
  
  CONCLUSIONS
  Our results demonstrate the additive effect of both anxiety and depression in impairing general health-related and tinnitus-specific quality of life and application of coping strategies, and reiterate the need for investigating both symptoms in the clinical evaluation of tinnitus patients.
authors.affiliation: Department of Otorhinolaryngology, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Bartels
authors.forename: B L
authors.initials: BL
authors.lastname: Middel
authors.forename: B F A M
authors.initials: BF
authors.lastname: van der Laan
authors.forename: M J
authors.initials: MJ
authors.lastname: Staal
authors.forename: F W J
authors.initials: FW
authors.lastname: Albers
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000342:Affective Symptoms; D000368:Aged; D001007:Anxiety / Q000150:complications*; D003863:Depression / Q000150:complications*; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014012:Tinnitus / Q000150:complications* / Q000523:psychology*